Expert: Lawrence Spindel DDS, www.lspindeldds.com - 2/20/2009

Question
I was having tooth pain with cold and sweet; it felt like the cold/sweet was shooting directly up the middle of my tooth and hit the nerve where I could literally hear a "pop/crack." I went to the dentist and had that tooth redone with a cavity. They took out the amalgam filling and put in a new, resin filling. I waited one week and the sharp pop/crack pain to the nerve was still present. So, I went back to the dentist and they told me to just wait a week, take Ibuprofen and Sensodyne
I've now been loaded up on Ibuprofen and Sensodyne for an additional 7 days and the sharp pain to the nerve is still occuring with cold/sweet.
The dentist said they could put a 2nd filling overtop the tooth and if that didn't work, it would have to be a root canal.

Before I go and spend another obscene amount of money on a 2nd filling, I want advice! Do I take the chance and spend the money to get a 2nd filling, or just go straight for the root canal? They won't even credit my account if I HAVE to have a root canal. So, if I do have to get the root canal after 2 fillings, they won't take into account the money i've already spent of the 2 fillings.


Answer
Dear Annamarie,

It is possible that you will eventually require a root canal, but before deciding on that it would be a good idea to try and determine why your tooth is so sensitive. If the bite is high, then that can cause sensitivity and you may require a bite adjustment.

Often teeth with old silver fillings develop internal cracks which are irritating to the nerves.  These cracks can be tiny and difficult to detect.  They can be seen by the dentist if he is using magnification and shines a bright light inside the tooth.  The dentist should be on the look out for white or black lines.

If your sensitivity to cold persists for over a month without improvement, you may want to have the filling removed either by your current dentist, or another dentist. Ask them to rule out a crack. I have an article on my dental office website that I think you may want to look at. Just copy and paste the link into your browser

http://www.lspindeldds.com/cracked_tooth_syndrome2

If your dentist does find an internal crack, that might be the cause of your sensitivity. If no crack is found, you might ask your dentist to place an interim medicated filling such as an IRM restoration, which can calm an 'unhappy' tooth down.

Teeth with internal symptomatic cracks can require root canal treatment, but in my practice, often I cover sensitive teeth with crowns that are cemented in with temporary cement. If the tooth is happy I cement the crowns permanently. If the sensitivity remains, then I recommend a root canal.

As to your financial concerns, all treatment cost money and often there are not real guarantees. It would be a good idea to discuss your financial obligations before undergoing any additional treatments. If you truly feel your dentist is being unreasonable you might seek a second opinion from another dentist.  

In my practice, if I place a filling such as you had, I certainly would consider giving you a partial or full credit for the cost of the filling, especially since it sounds like you will require further costly treatments on the tooth, but that is my personal decision and  dentists are free to not offer any refund.  

If you do not like the way your dentist is handling your treatment or the finances associated with it, then you can and should consider going to a different dentist.

I hope this information has been helpful and please feel free to contact me again with any future dental questions.